Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
Danish Epilepsy Center, Dianalund, Denmark.
Epilepsy Res. 2021 Feb;170:106547. doi: 10.1016/j.eplepsyres.2020.106547. Epub 2021 Jan 4.
This study aimed at providing valid estimates for the risk of clinically relevant seizure aggravation by recommended anti-seizure medications in patients with Genetic Generalized Epilepsy (GGE). To this aim, treatment response, side effects and paradoxical reactions to anti-seizure treatment were retrospectively assessed in a near-population based cohort comprising 471 adult GGE patients. A total of 1046 treatment attempts were analyzed (lamotrigine: 351, valproic acid: 295, levetiracetam: 249, primidone/phenobarbital: 94, zonisamide: 57). Under lamotrigine, seizure aggravation was observed in 15 patients (two patients during levetiracetam, one patient during zonisamide, none during phenobarbital and valproic acid). All but two patients with paradoxical reactions to lamotrigine were diagnosed with juvenile myoclonic epilepsy (JME), otherwise, the clinical and electroencephalographic characteristics of patients with paradoxical reactions did not differ. At treatment start, the estimated risk of a paradoxical reaction to lamotrigine was 7.9 % in JME patients (n = 190). For all GGE patients (incl. JME), the estimated risk of clinically relevant seizure aggravation under treatment with lamotrigine was 3.7 % (1.8 % for zonisamide and 0.8 % for levetiracetam). In conclusion, clinical significant aggravation of seizure frequency is common in lamotrigine-treated JME patients but rare in patients with other GGE subsyndromes or under treatment with other recommended anti-seizure medication.
本研究旨在为遗传性全面性癫痫（GGE）患者推荐的抗癫痫药物治疗相关临床显著癫痫加重风险提供有效估计。为此，我们对一个基于人群的近 471 例成年 GGE 患者队列进行了回顾性评估，包括治疗反应、副作用和抗癫痫药物治疗的矛盾反应。共分析了 1046 次治疗尝试（拉莫三嗪：351 次，丙戊酸：295 次，左乙拉西坦：249 次，苯妥英/苯巴比妥：94 次，唑尼沙胺：57 次）。在拉莫三嗪治疗下，15 例患者出现癫痫加重（2 例在左乙拉西坦治疗期间，1 例在唑尼沙胺治疗期间，1 例在苯巴比妥和丙戊酸治疗期间没有）。除了两名对拉莫三嗪出现矛盾反应的患者被诊断为青少年肌阵挛性癫痫（JME）外，其余患者均为 JME，否则，矛盾反应患者的临床和脑电图特征没有差异。在治疗开始时，JME 患者（n = 190）对拉莫三嗪出现矛盾反应的风险估计为 7.9%。对于所有 GGE 患者（包括 JME），拉莫三嗪治疗下临床显著癫痫加重的风险估计为 3.7%（唑尼沙胺为 1.8%，左乙拉西坦为 0.8%）。总之，拉莫三嗪治疗的 JME 患者中，癫痫发作频率的临床显著加重很常见，但在其他 GGE 亚型患者或其他推荐的抗癫痫药物治疗中很少见。
